Historical Context of Blood Pressure Screening in Dental Practice
When Dentists Started Taking Blood Pressure Readings
Dentists began routinely screening blood pressure in their offices during the mid-1970s, with formal documentation of systematic screening programs appearing as early as 1974-1976. 1
The earliest documented systematic blood pressure screening program in a dental setting was conducted at Virginia Commonwealth University's School of Dentistry between January 1974 and March 1975, where blood pressures were measured on all 2,222 dental patients admitted for treatment. 1 This pioneering effort demonstrated that approximately 6% of dental patients could be identified as having undetected hypertension and successfully referred to physicians. 1
Why Dentists Started This Practice
Primary Detection Role
Dentistry has played an important role in detecting patients with undiagnosed hypertension, particularly because dental visits often represent the only regular healthcare contact for certain populations. 2
The rationale for blood pressure screening in dental offices emerged from several key factors:
High prevalence of undetected disease: Beginning in 1976, the percentage of the U.S. population with undetected hypertension initially declined steadily, but this trend reversed starting in 1994, with fewer than 50% of patients aware of their hypertension having it medically controlled. 2
Unique access to at-risk populations: Approximately 6% of dental patients visit their dentist yearly but do not visit their physician during the same time period, making the dental office a critical screening venue. 1
Silent nature of the disease: Hypertension's lack of symptoms until serious complications occur makes opportunistic screening essential, and dental practitioners are often on the frontlines of prevention by evaluating preoperative blood pressure readings. 3
Patient Safety During Dental Procedures
Patients with very high blood pressure are at great risk for acute medical problems when receiving dental treatment, particularly during stressful procedures such as oral surgery, periodontal surgery, and dental implant placement. 2
The medical necessity for monitoring includes:
Risk of acute complications: Patients with undetected or uncontrolled hypertension are at high risk for stroke, heart disease, kidney disease, and retinal disease during dental procedures. 2
Increased medically compromised patients: Growing numbers of medically compromised patients seeking dental treatment require blood pressure monitoring during more stressful dental procedures. 2
Current Screening Effectiveness
Recent data demonstrates that screening blood pressure at the dental office can detect high blood pressure readings in a significant proportion of patients, with 50.1% of screened dental patients showing elevated readings and 38% of those being previously undiagnosed. 4
A 2022 study of 273 dental patients found:
137 patients (50.1%) had high blood pressure readings compared to 136 (49.8%) with normal readings. 4
54 patients (38%) with high blood pressure readings had never been diagnosed by a physician and were unaware of their blood pressure status. 4
Among patients previously diagnosed with hypertension, 63.3% still had high blood pressure readings at their dental visit, suggesting poor control. 4
5.3% of diagnosed patients were not taking their prescribed medications. 4
Implementation Barriers
Despite the clear benefits, the majority of dental hygienists are not routinely recording blood pressure readings, even though their dental hygiene school curriculum emphasized doing so for all patients. 5
Common barriers identified include:
Insufficient appointment time: The most frequently cited reason for not performing routine blood pressure screening. 5
Minimal value assigned by employers: Dental practice owners often do not prioritize this screening procedure. 5
Lack of systematic protocols: Many dental offices lack standardized procedures for when and how to screen. 5
Clinical Significance
Screening dental patients at every dental visit is efficient and beneficial, serving as a useful tool for both diagnosed and undiagnosed patients, and should be implemented at every visit. 4
The dental office represents a unique opportunity because:
Patients often have routine follow-up appointments and emergent visits that may represent their only healthcare contact. 3
Dental practitioners can perform risk assessments and determine when medical consultation is necessary. 3
The high prevalence of hypertension among the American population (affecting more than a billion people worldwide) makes opportunistic screening in any healthcare setting valuable. 3